Two hundred patients, aged 16 to 60 years, with a completely displaced midshaft clavicular fracture were randomized to evaluate the efficacy of open reduction and plate fixation, against nonoperative treatments. Patients were assessed over 12 months for union, functional outcomes (DASH, Constant Score, and SF-12), complications, and cost of procedures. The evidence presented in this study demonstrated that operative treatments for displaced midshaft clavicular fractures result in lower rates of nonunion and superior functional outcomes, but is associated with higher implant-related complications and heavier costs. The authors of this study indicated a reluctance to accept operative fixation as the routine procedure for displaced midshaft clavicular fracture.